The editorial by Malhi et al1 is a timely and most welcome wake‐up call regarding the declining use of lithium in the long‐term maintenance treatment of bipolar disorders. In support of the issues discussed, we would like to stress several topics which we believe can further help to make a better life for as many patients with bipolar disorders as possible. Given its long‐term effectiveness as evidenced

A concatenation of study findings published during the last decade have brought into cold clarity the predominance and debilitating nature of depressive symptoms in adults with bipolar disorders (BD). For example, results from longitudinal, naturalistic studies in BD have concluded that for the majority of affected individuals, depressive symptoms manifest as “polarity first” and “polarity predominant”

There has been growing scientific evidence in recent years that bipolar disorder (BD) is associated with alterations in the kynurenine (KYN) pathway. However, many of these studies have been limited by their focus on adults. Thus, this preliminary study investigated differences in the peripheral levels of KYN metabolites in children and adolescents with BD, unaffected offspring of parents with BD,

In their editorial “Make lithium great again!“ Malhi and collaborators1 reviewed the common misconceptions surrounding tolerability and ease of administration, and the clinical phenotypes to consider when prescribing lithium for bipolar disorders (BD). Despite clinical practice guidelines recommending lithium as a first‐line option in BD, its use appears to be declining. For example, in a recent analysis

Altered activity in the ventrolateral prefrontal and anterior cingulate cortices, as well as subcortical and amygdala projection sites, were previously reported during a first manic episode in youth with bipolar disorder and observed to be associated with treatment response. To extend these findings, we investigated functional connectivity among these regions in first‐episode manic participants who

Although Charles Frederic Gerhardt was the first to create acetylsalicylic acid in 1853, Felix Hoffman, a chemist working for Bayer, is credited with the synthesis as he acetylated acetylsalicylic acid in 1897. This became modern day aspirin we use widely for pain relief. In 1950 Lawrence Craven, a general practitioner first hypothesized that aspirin could be used preventatively for thrombotic events

Bipolar disorder has been associated with an increased risk for neurodegenerative diseases, but uncertainties remain. The risk relative to other psychiatric disorders is not established.

Identifying early clinical phenotypes that may be indicative of an emerging psychiatric condition has been a major focus of public health and medicine, and to this end, extensive effort has been expended to develop clinical staging models of disease.

As a common model for adverse early experience and depression, maternal separation (MS) is always used to investigate the psychological disease. Despite extensive and strong evidence verified the depression‐like state induced by MS, little is known about the specific mechanism of MS. Therefore, the present study aimed to investigate the neurobiology mechanism of the MS‐induced depression‐like state

To the Editors, On February 20, 2020 the first case of coronavirus disease (COVID‐19) was diagnosed in Italy. In a few weeks the Policlinico A. Gemelli Hospital in Rome became a so called “COVID Hospital”, so its structure changed and consequently also the organization of the clinical activities of the Psychiatric Unit. In particular, outpatient services (ambulatory and day hospital) have guaranteed

Key Message The current pandemic has directly affected individuals suffering from Bipolar Disorder, since they depend on a well‐balanced routine, regular sleeping hours, and sparse psychological stress in order to prevent relapses. Therefore, we discuss Emotion Regulation strategies to help patients deal with the heightened psychological distress inflicted by the current pandemic.

Cognitive impairment affects many patients with bipolar disorder (BD), and treatments with replicated pro‐cognitive effects are lacking. This study aimed to assess the effect of Action‐Based Cognitive Remediation (ABCR) vs. control treatment on cognitive impairment in patients with BD.

1 INTRODUCTION We agree in general with Malhi et al's forthright Editorial “Make Lithium Great Again”, where they reiterate that, despite its clear efficacy and effectiveness, lithium remains under‐utilized in the treatment of bipolar disorder. Possible reasons they give for this include prescription of second generation antipsychotics (SGAs), which may appear easier to prescribe, are marketed better

Bipolar disorder (BPD) is a highly heritable psychiatric disorder whose genetic complexity and pathogenetic mechanisms are still being unraveled. The main goal of this work was to characterize BPD risk‐gene candidates (identified by Nurnberger et al., JAMA Psychiatry 71:657, 2014, and Stahl et al., Nat. Genet. 51:793, 2019) with respect to their evolutionary conservation, associated phenotypes, and

Bipolar I disorder (BD‐I) is associated with a high risk of suicide attempt; however, the neural circuit dysfunction that confers suicidal vulnerability in individuals with this disorder remains largely unknown. Resting‐state functional magnetic resonance imaging (rs‐fMRI) allows non‐invasive mapping of brain functional connectivity. The current study used an unbiased voxel‐based graph theory analysis

Excess mortality is a critical hallmark of bipolar disorder (BD) due to co‐occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk.

Bipolar Disorder (BD) is associated with a decrease in cellular resilience. Despite the half a century old discovery of lithium’s efficacy for the treatment of BD, its exact mechanisms remain elusive. Accumulating data suggests lithium’s cytoprotective properties involve the modulation of several UPR proteins, such as GRP78. Mesencephalic astrocyte‐derived neurotrophic factor (MANF) is an endoplasmic

Almost two decades after a worldwide call of Wirz‐Justice and collaborators published in Science for including light therapy (LT) in the therapeutic armamentarium of major depressive episodes (MDE), LT is still absent from international therapeutic guidelines. Psychiatrists’ resistance to non‐conventional therapeutics, although natural, usually results from lack of knowledge of mechanisms and response

1 BACKGROUND First used over 80 years ago, electroconvulsive therapy (ECT) is the oldest of the currently used biological treatments in psychiatry. ECT is indicated for severe depression, mania, treatment‐resistant schizophrenia psychosis, catatonia, and comorbid depression in dementia. ECT delivers a unilateral or bilateral electrical stimulus to the brain of an anesthetized patient to induce a generalized

Bipolar Disorder (BD) is a chronic mental health disorder with significant morbidity and mortality. Age at onset (AAO) may be a key variable in delineating more homogeneous subgroups of BD patients. However, no known research has systematically assessed how BD age at onset subgroups should be defined.

It has been proposed that different stages of bipolar disorder may be underpinned by distinct neurobiological substrates. However, structural neuroimaging studies in early stages of the illness are limited by small sample sizes yielding inconsistent findings. The purpose of this systematic review and meta‐analysis, therefore, was to identify regional grey matter volume (GMV) changes that are consistently

The “Bipolar Disorders: Improving Diagnosis, Guidance, and Education” (BRIDGE‐II‐Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC).

Over the past 20 years, there has been a modest but increasing interest in the therapeutic potential of ketogenic diet (KD) for bipolar disorder. The rationale is that some anti‐epileptics are mood‐stabilizers, and KD is a recognized treatment for refractory seizures. One study described a positive impact of KD in 2 patients with type 2 bipolar disorder(1). Another publication reported no effect of

Bipolar disorder (BD) is characterized by severe mood symptoms, often accompanied by circadian rhythm disturbances. Preclinical studies indicate that lithium, a first line treatment for BD, has effects on circadian rhythms. 1 However, less attention has been given to the effects of lithium on the clinical symptoms of BD related to circadian rhythm disruption. We present a case of a BD patient with

To the Editors Lithium, widely used in treating bipolar disorder, also exhibits antiviral activity.1 Lithium's antiviral effects may extend to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease 2019 (COVID‐19).2 Experimental data show that SARS‐CoV‐2 inhibition starts at very high lithium levels (>5 mEq/L).2 This preliminary study investigates whether trace

Cardiovascular disease (CVD) is exceedingly prevalent, and occurs prematurely in individuals with bipolar disorder (BD). Cardiorespiratory fitness (CRF), arguably the most important modifiable CVD risk factor, is also associated with brain structure and function. There is a gap in knowledge regarding CRF in BD, particularly in relation to brain structure.

Mental disorders are highly prevalent, heterogeneous conditions comorbid with multiple chronic physical illnesses, remaining the leading cause of disability worldwide.1 Its diagnosis and management are limited by the absence of available biomarkers and have largely been dependent on patient’s subjective self‐reporting obtained at periodic clinician’s evaluation that are frequently influenced by recall

Bipolar disorder is a psychiatric disorder, most often characterized by episodes of mania, hypomania and depression. Bipolar disorder predominantly affects young adults. Patients with bipolar disorder have a waxing and waning clinical course and experience multiple relapses and remissions. Furthermore, they face notable difficulties in achieving balance in important aspects of life: mood, sleep, overall

This is a 38‐year‐old married registered nurse diagnosed with ultra‐rapid cycling bipolar disorder presenting with an unusual picture of primarily manic/hypomanic episodes (at a ratio of approximately 10:1) vs. depressive episodes. The patient’s illness started at age 19 and was marked by psychotic mania along with classic manic symptoms. Resisting formal treatment for some 3 years, a primary treatment

NIMH funding for clinical treatment studies for children and adults with bipolar disorder has gone from minimal to almost nonexistent.

In healthy populations, caffeine appears to have beneficial effects on health; however, patients with bipolar disorder (BD) are routinely advised to limit caffeine use in psychoeducation programmes. We aimed to examine all literature reporting whether caffeine intake/withdrawal impacts the natural course of BD, in terms of clinical outcomes.

I would like to refer to the article by Nunez and colleagues 1 concerning their meta‐analysis of randomized trials of the efficacy and safety of modafinil/armodafinil in bipolar depression to raise the question of a possible shift in the treatment of this condition. The depressive phases and residual depressive symptoms are the main drivers of detrimental consequences such as poor functioning, suicidal

MM, a Caucasian male of Ashkenazi Jewish ancestry, developed auditory hallucinations as a teenager after abusing 3,4‐methylenedioxy​methamphetamine (MDMA/ecstasy) and prescribed stimulants for attention‐deficit, hyperactivity disorder (Fig. 1). At 18 years old, he developed psychomotor agitation, euphoria, expansive delusions, rapid speech, and a decreased need for sleep, for which he was hospitalized

Better intervention strategies for patients with treatment‐resistant depression are greatly needed. McIntyre and colleagues1 set out to investigate the effectiveness of intravenous (IV) ketamine through a chart review of 201 such outpatients that all received four IV ketamine infusions over one‐to‐two weeks. They concluded that IV ketamine was effective in treating anxiety, irritability, agitation

In a recent Editorial, Malhi et al.1 stress how underutilized lithium is and the importance of rectifying this deficiency. Across published treatment guidelines for bipolar disorder, lithium is universally considered the gold standard and the recommended first line treatment for prophylaxis. So, why is it then prescribed less and less? In addition to the crucial points raised by Malhi et al.1, we offer

Introduction of lithium carbonate to treat manic excitement in 1949 by John Cade in Melbourne opened a new, revolutionary era in psychiatry with the first clinically effective pharmacological treatment for a major psychiatric disorder. By 1960, there followed explosive discovery and development of at least one of every class of psychotropic medicines currently available.1 Further development of lithium

Thyroid dysfunctions must be suspected in patients with mood episodes. Thyrotoxicosis may manifest as manic episodes with mixed features, with a severe presentation, including suicidality. Patients with affective disorders should be screened for thyroidopathy. A strategy combining thionamides, betablockers and psychotropics may lead to an efficient stabilization of mood symptoms.

Patients with Velocardiofacial syndrome can present with recurrent mania in adolescence, and may have poor response and tolerability with conventional treatments. Complex and variable clinical manifestation and comorbidities can complicate the management and require multidisciplinary approach. Clinicians should consider ECT in the early stages of treatment along with mood stabilizers.

Malhi and coworker’s editorial1 offers several reasons explaining the decline in the use of lithium to treat Bipolar Disorder (BD) against the recommendation of most international guidelines. Among the reasons, the authors state (1) the lack of “patent” on lithium, (2) its need for monitoring, and (3) concerns about its long‐term adverse effects. Moreover, the authors refer to the displacement of lithium’s

Based on data from the 1997‐2016 National Ambulatory Care Surveys, dramatic changes have occurred in the treatment practices of psychiatrists caring for patients with bipolar disorder (1). These trends include an increase in the prescription of antipsychotics from 19.1% to 52.7% and a concomitant decrease in the prescription of mood stabilizers, including a decrease in the use of lithium from 30.4%

Frustration is associated with impaired attention, heightened arousal, and greater unhappiness in youths with bipolar disorder (BD) vs healthy volunteers (HV). Little is known about functional activation and connectivity in the brain of BD youths in response to frustration. This exploratory study compared BD youths and HV on attentional abilities, self‐reported affect, and functional activation and

Key Message We propose a swift transition to an e‐health approach during the COVID‐19 pandemic, in order to provide preeminent treatment for patients with bipolar disorder. Guidelines regarding use of internet‐based programs, self‐monitoring platforms, and daily routine adjustments are offered. All recommendations are evidence‐based and offer safe directions for mental health professionals. Learning

To investigate oxidative stress markers and antioxidants in bipolar disorder (BD).

The traditional system of classifying postpartum psychiatric disorders into maternity blues, postpartum depression, and puerperal psychosis overlooks the clinical significance of hypomanic, manic, or mixed symptoms in the postpartum period. Although common after childbirth, episodes of hypomania or non‐psychotic mania, as well as mixed states, are generally not included in the traditional nomenclature

In the May 6th Issue of the Australia and New Zealand Journal of Psychiatry, Malhi et al. published a Reflection1 asserting that the use of the term paediatric bipolar disorder (PBD) should be abandoned. Referencing unreplicated studies and dated citations, the authors incorrectly infer from administrative database studies that rates of bipolar disorder diagnoses are rising among youth, critically

The aims of the present study thus were (a) to further investigate the association between lithium levels in drinking water and suicide rates by adjusting relevant factors using the so far largest available dataset in Japan, (b) to confirm sex differences, (c) to estimate the effects of long‐term exposure to trace lithium, (d) to investigate the effects of drinking bottled instead of tap water, and

Pinto et al. recently published a systematic review and meta‐analysis of randomized controlled trials (RCTs) investigating efficacy and tolerability of cariprazine in the treatment of bipolar disorder. In their analysis, authors included 7 RCTs, out of 225 studies screened after duplicates removal, synthesizing effect sizes of RCTs for manic/mixed and depressive episodes.1 The study found that cariprazine

In this case report, we describe the results of next generation non‐targeted cerebrospinal spinal fluid (CSF) metabolomics in a patient presenting with a prolonged delirium and elevated serum ammonia after standard electroconvulsive therapy treatment. These studies subsequently, in part, revealed abnormalities in the citric acid cycle, a finding previously reported in the bipolar literature. The patient

Multiple medical or neurological conditions may mimic or contribute to a patient’s neuropsychiatric symptoms. In a retrospective chart review of 252 patients with a neurodegenerative disease who attended a specialty clinic, it was found that 28.2% of them received a prior psychiatric diagnosis (1). We herein present a clinical vignette involving an elderly Chinese lady with a historical diagnosis of

The aim was to describe the pre‐diagnostic and post‐diagnostic psychopharmacological treatment of bipolar disorder over the past two decades.

The long‐term use of lithium salts has long been associated with tubular damage and chronic kidney disease development. Nevertheless, there is some interest in the potential role of these drugs in inflammatory pathways regulation including those pathways in the setting of acute kidney injury (AKI). This therapeutic potential is based on lithium‐induced inhibitory phosphorylation of glycogen synthase

The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non‐symptom) outcomes following psychosocial intervention.

Neurovascular abnormalities are relevant to the pathophysiology of bipolar disorder (BD), which can be assessed using cerebral blood flow (CBF) imaging. CBF alterations have been identified in BD, but studies to date have been small and inconclusive. We aimed to determine cortical gray matter CBF (GM‐CBF) differences between BD and healthy controls (HC) and to identify relationships between CBF and

Recent evidence has associated mood disorders with blood‐brain barrier (BBB)/ neurovascular unit (NVU) dysfunction, and reduction in blood vessels coverage by the water channel aquaporin‐4 (AQP4) immunoreactive astrocytes. Lithium is an established treatment for mood disorders, yet, its mechanism of action is partially understood. We investigated the effects of lithium on BBB integrity and NVU‐related

Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, but current diagnostic systems demonstrate a move towards dimensional rather than categorical approaches to classifying personality pathology. We aimed to examine the presence and severity of borderline personality traits in bipolar I and bipolar II disorder

Emotion regulation difficulties precipitate and exacerbate acute mood symptoms in individuals with bipolar disorder (BD), and contribute to suicidal behavior. However, few studies have examined regional brain responses in explicit emotion regulation during acute BD mood states, or hopelessness, a major suicide risk factor. We assessed brain responses during explicit emotion regulation, and their relationship

Cognitive remediation therapy (CRT) may benefit people with bipolar disorder type I and II for whom cognitive impairment is a major contributor to disability. Extensive research has demonstrated CRT to improve cognition and psychosocial functioning in people with different diagnoses, but randomised trials of evidenced therapy programmes are lacking for bipolar disorders. The Cognitive Remediation in

Lithium remains an important treatment for mood disorders but is associated with kidney disease. Nephrogenic diabetes insipidus (NDI) is associated with up to 3‐fold risk of incident chronic kidney disease among lithium users. There are limited randomized controlled trials (RCT) for treatments of lithium‐induced NDI, and existing therapies can be poorly tolerated. Therefore, novel treatments are needed

There is substantial evidence of increased prevalence of migraines, and negative psychiatric correlates of migraines, in adults with bipolar disorder (BD). Given the paucity of data on this topic in youth, we investigated the prevalence and correlates of migraine in a large sample of adolescents with BD.

This review aim was to examine whether psychotherapy is more or less effective in patients with SUD, compared to those without; whether there is a differential effect of a particular psychotherapy in patients with SUD.